Last Wednesday evening, a 22-month-old child tripped and fell into an icy tributary of Buffalo Creek, outside Mifflinburg, Pennsylvania. The boy was quickly swept downstream for about a quarter of a mile before being washed up on a grassy knoll, which was where a neighbor later found him. The infant had no pulse and was not breathing at the time of discovery and may have been in the 1oC (34oF) water for as long as 30 minutes.
According to PennLive, emergency services were immediately called and as soon as they arrived they began to perform CPR on him, which continued uninterrupted as they made their way to Evangelical Community Hospital before boarding a helicopter destined for Geisinger.
Upon arrival, the child still had no pulse and his body temperature was a mere 25oC (77oF), which is substantially lower than the normal body temperature of 37oC (98.6oF), so attempts to resuscitate him were continued alongside administering fluids to warm him. The medical team was ready to admit him into surgery in order to place him on a heart bypass machine, but a pulse was finally detected after 20 minutes so doctors decided to carry on with resuscitation and warming efforts. Amazingly, CPR was carried out for a total of one hour and 41 minutes, which required the hands of many as it is such a tiring procedure.
Once he reached a more reasonable body temperature, the boy was given blood pressure medicine and placed on a ventilator. Amazingly, he woke up at 2am Thursday and, despite everything, he suffered no neurological damage. Five days on, he returned home with his parents, who said that he is healthy, smiling and talking again.
So how did he manage to make it through this dramatic event? His seemingly miraculous survival is attributable to a combination of two main factors: his age, and the fact that he fell into extremely cold water. And here’s why.
The most serious consequences of immersion are lack of oxygen, or hypoxia, and the effects that this has on the heart and brain. Cold water can actually help protect against these effects by two different mechanisms. First, it triggers something known as the diving reflex, which helps to conserve oxygen by slowing down the heart and shifting blood to vital parts of the body, such as the brain. Interestingly, this response is much stronger in children, which is part of the reason that children are more likely than adults to survive after prolonged submersion.
Second, cold temperatures and swallowing of water can quickly lead to hypothermia. Body temperatures below 30oC cause brain tissue to become significantly resistant to hypoxia and also reduce its energy consumption by around 50%. Our bodies are equipped with temperature regulation mechanisms, but these are not fully developed in infants, making them more susceptible to hypothermia. Furthermore, children also have higher surface area to body mass ratios and less body fat than adults, meaning they cool much faster and thermo-regulate less efficiently.